What are the NCCN treatment guidelines for menopausal symptoms in cancer survivorship?

Updated: Feb 28, 2018
  • Author: Winston W Tan, MD, FACP; more...
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The NCCN concurs that menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms. Contraindications to MHT include the following [13] :

  • History of hormonally mediated cancers
  • History of abnormal vaginal bleeding
  • Active or recent thromboembolic event
  • Pregnancy
  • Active liver disease

MHT should be used with caution in women with coronary heart disease or hypertension, those at increased genetic risk for cancer, and current smokers.

Addditional NCCN recommendations for the use of MHT are as follows [13]

  • Use the lowest dose possible to control symptoms
  • Tissue-selective estrogen complex (TSEC; conjugated estrogens/bazedoxifene) is contraindicated in survivors of hormonally dependent cancers
  • Custom-compounded bioidentical hormone therapy lacks evidence supporting claims that it is a safer and more effective alternative to standard hormone therapies
  • Patients should be referred to a specialist for MHT management
  • In younger survivors experiencing menopause, MHT or oral contraceptives, if not contraindicated, should be considered for both symptom relief and cardiac and bone benefits

Other NCCN-recommended pharmacologic treatments for relief of vasomotor symptoms include the following:

  • Low-dose antidepressants
  • Anticonvulsants
  • Neuropathic pain relievers
  • Antihypertensives

Nonpharmacologic recommendations include the following [13] :

  • Acupuncture
  • Exercise
  • Weight loss in overweight or obese patients
  • Cognitive-behavioral therapies
  • Yoga
  • Hypnosis

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